LETTER TO THE EDITOR
|Year : 2021 | Volume
| Issue : 1 | Page : 139-140
Lost umbilical tape in laparoscopic surgery: Consequences and lessons learned
Saket Kumar, Nishant Kurian, Rakesh Kumar Singh
Department of Surgical Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
|Date of Submission||12-Dec-2019|
|Date of Decision||20-Jan-2020|
|Date of Acceptance||27-Jan-2020|
|Date of Web Publication||24-Feb-2020|
Dr. Saket Kumar
Department of Surgical Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kumar S, Kurian N, Singh RK. Lost umbilical tape in laparoscopic surgery: Consequences and lessons learned. J Min Access Surg 2021;17:139-40
Lost foreign body during minimally invasive surgery may lead to serious problems. Retrieval of the lost object leads to prolongation of surgical time, and in rare instances, exploratory laparotomy may also be required.
Recently, we encountered an interesting case in which a missing umbilical tape could not be traced and required conversion to open. The tape was finally retrieved from a very unusual location after reviewing the surgical recording. This incident emphasises the significance of maintaining surgical counts, using radiopaque markers and also recording the operative procedures.
A 14-year-old girl with a 6-month history of pain in the upper abdomen was diagnosed with a choledochal cyst. She underwent laparoscopic choledochal cyst excision in the elective setting. At the end of the procedure, the scrub nurse reported discrepancy in the surgical item count. An umbilical tape, which was used for looping the choledochal cyst, was noted missing. The laparoscope was reintroduced in the abdomen and a thorough search for the missing umbilical tape was made. Anatomical recesses, interbowel loop and other probable sites were looked for. Despite a thorough and meticulous search, the missing tape could not be located laparoscopically. As the umbilical tape was without a radiopaque marker, fluoroscopic localisation was not possible. At last, the procedure had to be converted to open and the search was continued. Meanwhile, the counts were repeated several times and frantic search for the missing tape was done outside. After a futile 90 min exercise, the search was called off and the abdomen was closed. The surgical team later decided to review the operative video as a last resort to locate the umbilical tape.
The surgical video was replayed and was minutely scrutinised. On review, it was realised that the umbilical tape was not readily removed after use and was left purposeless in the surgical field. As the patient had mild oozing during the procedure, intermittent suctioning was done to clean the operative field. In one of the video frames, the umbilical tape was seen getting aspirated into the suction tube. The suction jar was then emptied and the tape was found lying at the bottom of it. The patient had an uneventful postoperative recovery and was discharged on postoperative day 6.
Surgical counting at the end of the procedure is essential to prevent unintended retained surgical items (RSIs). The reported incidence of RSI varies between 0.3 and 1.0/1000 abdominal operations. RSIs can be a cause of significant postoperative morbidity and even mortality, leading to litigations and criminal lawsuit. Routine intraoperative radiography and use of radiofrequency-tagged sponges have been suggested to locate the missing or RSIs.
Our case describes an unusual situation where an umbilical tape got sucked and led to conversion of minimally invasive procedure to open. This increased the operative time and prolonged the hospital stay of the patient. This experience underscores the importance of exclusively using radiopaque marked items during surgery and removing them as soon as their purpose is served.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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